STIMULANTS. — Alcohol is given by some in a routine way in all cases. The practice should certainly be condemned. Alcohol, like other drugs, produces dif ferent effects on different persons, and it is not known how much digestion and assimilation may be interfered with, especially in patients who have been quite unaccustomed to its use. In the mild form of the disease alcohol is un necessary, patients doing better without it.
In severe forms, especially when pa tients have been in the habit of drinking, also to old and feeble persons, alcohol may be given in moderate quantities, commencing about the middle of the second week after the headache has sub sided. When there is great prostration, this remedy is of positive benefit, when, for instance, the pulse is frequent and feeble and ataxic symptoms are present. It may be then given in from S to 12 ounces in twenty-four hours. It is doubt ful if such large quantities as 1 ounce every hour is ever of any real benefit. There is too great a tendency to depend upon this agent to the neglect of other means of restoring the strength. Ether given subcutaneously will sometimes re vive a patient temporarily. Alcohol may be given in the form of brandy or whisky, diluted with water, or in milk-punch. Wines, especially champagne, may be or dered when there is irritability of the stomach.
Water internally and externally les sens or mitigates the effects of toxaemia, to a far greater degree than any form of treatment thus far employed. The ne cessity for stimulants is also lessened in a degree by prompt treatment of diar rhcca, which contributes to exhaustion. When toxmmia is manifest by excite ment,—active delirium, flushed face, in jected eye, restlessness, twitchings, delu sions, etc.,—stimulants are to be avoided and applications of cold are of utmost service. The only drug of service is opium. Five or 10 minims of the de odorized tincture of opium every three or four hours has acted happily in most cases under the circumstances. When, however, the toxmmia is manifest by adynamia,—dullness, stupor, subsultus, frequent dicrotic pulse; hot, dry skin; dry, brown tongue; scanty secretions, and muscular \V eaknes s,—the employ ment of stimulants is imperative. They
should be used in small doses at long in tervals, but should be increased or de creased in amount and in frequency with the symptoms. If the tongue becomes moist, the delirium lessens, peaceful sleep ensues, and the kidneys become more act ive, our stimulation is successful. if the symptoms are aggravated, notably the delirium increased and renal secretion lessened, we must proceed more cau tiously and employ other than alcoholic stimulants. It is better at first to err with too little than with too much stimulation. If alcohol is noticed on the breath one hour after its imbibition, the patient is getting too much. The best guide as to the good effects of stimula tion is seen in the renal secretion. If this keeps above 50 ounces in twenty-four hours, plenty of water being used inter nally, no anxiety need arise, and, if GO to 100 ounces is secreted, the prognosis is good. Musser (Then Gaz., Apr. 15, 1900).
Medicinal Treatment —A number of different remedies have been used as spe cifics; such, for instance, as iodine and calomel, as recommended by Liebermeis ter. Iodide of potassium, quinine, digi talis; coal-tar derivatives, turpentine and sulphurous acid; and sulphocarbolates have all had their advocates, and have, after a time, been discarded; some as simply useless and others as more or less dangerous. At the present time, in addi tion to the general management already detailed, cases of typhoid fever are, as a rule, treated according to one of four different methods: 1. The expectant method, by which is meant the treating of symptoms as they arise and the guiding of the cases safely through the disease. This plan is to be recommended in mild cases when the temperature does not rise, as a rule, over 102°, and when the poison seems to exert little effect on the degeneration of tissues. It has, however, been abundantly proved by statistics that the expectant method is inadequate for the successful treatment of severe forms of the disease, and that the mortality under its use is greater than that ender some other modes of treat ment.